Local Legal Infrastructure and Population Health

This article examines the association between legal structures and population health indicators to better understand law’s contribution to community health. The authors posit that the legal infrastructure of local public health, as expressed in the exercise of local fiscal and legislative authority, affects local population health outcomes.

This study examined public health jurisdictions with at least 100,000 residents drawn from the 1998 and 2006 surveys by Mays et al. The dependent variable was premature mortality rates as reported by the Mobilize Action Toward Community Health (MATCH) database. Four independent variables were examined: home rule, county government structure, board of health power, and type of public health delivery system.

Key Findings:

County government structure had a strong and statistically significant effect on premature death.

Home rule had no statistically significant effect on premature death.

A 1 percent increase in poverty in a county without reformed government was associated with 168 years of potential life lost per 100,000 population; among counties with reformed governments, 111 years of potential life lost per 100,000.

These findings show the effect of poverty on premature death may be mediated by county government structure, which communities have power to change. More research is needed to understand the relationship between legal infrastructure and population health.